Ebola in America: The Crisis Widens

What inexcusable incompetence. The fact that the Centers for Disease Control and Prevention allowed a nurse who had cared for an Ebola patient to board a commercial airplane despite a 99.5-degree fever is shocking. All that was needed was common sense — no M.D. required. Protocol is never a replacement for good judgment.

Medical care in the United States has traditionally been judged superior to that of many other developed nations. Generous funding of research and education, a culture of meritocracy and a lesser bureaucratic burden have all been factors.

More recently, however, public support for research and education has been reduced, while freedom from bureaucracy has yielded to onerous insurance and governmental regulation. As a result, the superiority of American medicine is waning. Our generally dismissive attitude toward non-American research and education has persisted, however.

The hazards of such an approach are well illustrated by the failure to learn from guidelines developed by Doctors Without Borders and others. As quoted in the article, Sean G. Kaufman, who oversaw infection control at Emory University Hospital while it treated two Ebola patients, warned the Centers for Disease Control and Prevention that its guidelines were lax, but states that “they kind of blew me off.”

This sort of scientific parochialism can come at a high price, as we are now learning.

MICHAEL JACOBSON New York, Oct. 16, 2014

The writer is an internist.

To the Editor:

I have been teaching health care classes professionally for nearly 30 years. In that time, it has become clear that many health care administrators are more concerned about saving time and money than they are about saving and protecting lives. Especially for low-paying, low-level jobs, administrators sometimes look the other way, even when it should be obvious that applicants lack the medical aptitude to perform their job safely. And with more and more recent immigrants entering the field, there are many people who simply do not understand what physicians, co-workers and patients are saying.

Containing Ebola means setting and enforcing strict protocols. Just one weak link in the chain is a recipe for disaster. So administrators need to be vigilant in their hiring, training and supervision of health care workers, to ensure that patients — as well as the community at large — are safe.

The tragic story of Diana Flomo and her newborn daughter, both of whom died in Liberia possibly from Ebola, demonstrates the enormous weaknesses of a health system struggling to cope with Ebola without protocols and with little support.

No one knows for sure what caused Ms. Flomo and her daughter to die, but pregnant women and their babies in Liberia are clearly at high risk, even if they are not infected. On-the-ground assessments from the World Health Organization, Unicef and Save the Children indicate that access to skilled birth attendants, already low in West Africa, is falling dramatically in Liberia and Sierra Leone.

So often, such tragedies in West Africa go unnoticed. I hope that this story will encourage the rest of the world to step up its support to end the Ebola crisis and strengthen health systems across the continent.

CAROLYN MILES President and Chief Executive Save the Children U.S. Fairfield, Conn., Oct. 13, 2014

A version of this article appears in print on , on Page A30 of the New York edition with the headline: Ebola in America: The Crisis Widens . Order Reprints | Today’s Paper | Subscribe

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